1. Horizontal and Lateral Violence in Nursing:
Putting an End to Relational Aggression
Lynn Scott
State University of New York Institute of Technology
March 23, 2013

2. Definitions Horizontal violence is also known as: Lateral violence,
Bullying, and
Relational aggression.
Horizontal violence and lateral violence (HV/LV) are defined by Becher and Visovsky (2012) as a broad term used to describe unsolicited, undesired abuse, aggression, or hostility within a nurse’s work environment.

3. Definitions (cont’d)
Bullying is defined by Ortega., Christensen, Hogh, Rugulies & Borg (2011)“persistent negative actions directed towards one or more targets, it involves more than a single act, and the targets end up unable to defend themselves” (p. 753).
Malign bullying: purposeful.
Nonmalign bullying: unintentional.

4. Definitions (cont’d)
Relational aggression is defined by Dellasega (2009) as a type of bullying typified by various forms of psychological (rather than physical) abuse. It includes such behaviors as gossiping, withholding information, and ostracizing” (p. 52).

6. Examples of HV/LV Criticizing Intimidation Blaming
Arguing among coworkers
Refusing to assist or support another staff member
Public humiliation
Withholding necessary information
Undermining the efforts of specific individuals
Gossiping
Name calling
Fabricating or storytelling
Threatening
Isolating
Assigning unfair workloads
Demonstrating negative facial expressions (i.e., rolling of eyes, mocking)

7. Examples of HV/LV (cont’d)

8. Causes of HV/LV Nursing viewed as oppressed and powerless profession
Perpetrators have high level of self-interest, personal and psychological problems, and a need for power
Organizational and/or management problems
Nurse educators do not provide nursing students with a voice
Demonstration of lack of confidence and experience in novice nurses and/or new hires

9. Precedence and Incidence of HV/LV
The prevalence of HV/LV is not unique to the nursing profession.
Relational aggression is common in the field of education.
HV/LV is only recently recognized, so the incidence of HV/LV in nursing is not accurately known.
As of 2009, 25% of nurses studied reported experiencing bullying with 18 nurses reporting some act of HV/LV up to two times a day.
As many as double that number report having experienced three or more acts of HV/LV on a daily to weekly frequency.
Being in the position of new graduate or new hire increases the risk of being a victim of HV/LV.

10. Increased psychological stress at work
Effects of HV/LV
Increased psychological stress at work
Decreased cohesiveness of unit as evidenced by poor teamwork, ineffective communication, severed relationships, and negative work environment
Decreased physical and mental health manifested by headaches, gastrointestinal problems, back and neck pain, depression, anxiety, low self-esteem, self-hatred, and self-doubt
Increased cost to healthcare institution due to employee absenteeism, high turnover, and cost of training new employees

11. Nursing theory related to HV/LV
Patricia E. Benner’s From Novice to Expert (1982):
Novice
Advanced beginner
Competent
Proficient
Expert
Novice nurses are mentored
and trained by expert nurses. In the presence of HV/LV, the pathway from novice to expert cannot progress in the presence of disruptive behaviors that threaten the physical and mental wellbeing of a new employee.

12. Solutions to eliminate HV/LV
Solutions for the elimination of HV/LV among nurses are the responsibility of all employees, nurse managers, educators, and administrators.
Employees need to stand strong and speak up for themselves in the face of adversity.
Managers need to promote and model respectful communication to all employees and peers.
Educators need to provide opportunity for education on the resolution of HV/LV in nursing relationships.
Administrators need to breakdown the hierarchy of healthcare politics and create an atmosphere of democracy that will encourage all employees to stand behind their own convictions.

13. Solutions (cont’d)
Use of cognitive rehearsal to provide nurses with combat skills against HV/LV (Embree & White, 2010).
Empowerment through the mentoring and nurturing of nursing students and new nurses (Jones, 2011).
Administrative creation of a more democratic, less hierarchical work environment and a zero tolerance policy for HV/LV in the workplace (Dellasega, 2009).
Management support by the transition of unit rules and behaviors and the establishment of a blame-free environment through the acknowledgement of complaints, quick action to resolve conflicts, and recognition of employees’ fears of confrontation and retaliation (Rocker, 2012).

14. Solutions (cont’d)
Education and professional development opportunities for all employees (including managers and educators) to prevent and/or eliminate HV/LV in the workplace, identification of direct approaches to behavior modification, and review of consequences (Becher & Visovsky, 2012).
Modeling of acceptable professional interactive behavior and communication by nursing leaders.

15. Conclusion
Nursing management, leadership, administration and education must efficiently work together to educate their nursing employees about the prevention and solutions against HV/LV, create and model an environment of equality and respect, and enforce intolerance for any HV/LV actions and behaviors of HV/LV in the workplace.

16. References
American Nurses Association (2011). Lateral violence and bullying in nursing. Retrieved on 03/20/13 from factsheets/lateral-violence-and-bullying-in- nursing.html. Becher, J., & Visovsky, C. (2012). Horizontal violence in nursing. MedSurg Nursing, 21(4), pp CurrentNursing.com (2011). From novice to expert: Patricia E. Benner. Retrieved on 03/22/13 from Patricia_Benner_From_Novice_to_Expert.html. Dellasega, C.A. (2009). Bullying among nurses. AJN, American Journal of Nursing, 109(1), pp

17. References (cont’d)
Embree, J.L., & White, A.H. (2010). Concept analysis: Nurse-to-nurse lateral violence. Nursing Forum, 45(3), pp King-Jones, M. (2011). Horizontal violence and the socialization of new nurses. Creative Nursing, 17(2), pp New York State Nurses Association (n.d.). Violence in healthcare settings: A resource guide for nurses. Retrieved on 03/20/13 from _safety/violenceHealthcareBklt.pdf.

18. References (cont’d)
Ortega, A., Christensen, K. B., Hogh, A., Rugulies, R., & Borg, V. (2011). One year prospective study on the effect of workplace bullying on long-term sickness absence. Journal of Nursing Management, 19, pp doi: /j x. Rocker, C.F. (2012). Responsibility of a frontline manager regarding staff bullying. Online Journal of Issues in Nursing, 17(3), pp. 1-15

19. Picture References Slide 5: Retrieved on 03/23/13 from
content/uploads/2011/04/Sketch
06-04_20_43.png.
Slide 7, Picture 1: Retrieved on 03/23/13
from
images/Nursing%20Practice/
latviolence.jpg.
Slide 7, Picture 2: Retrieved on 03/23/13 from

20. Picture References (cont’d)
Slide 7, Picture 3: Retrieved on 03/23/13 from column_images/Tech-on-Tech-024A.png. Slide 7, Picture 4: Retrieved on 03/23/13 from SharedResources/Images/2012/010912/ HorizontalViolence_250x.jpg. Slide 15: Retrieved on 03/23/13 from wkplace-violence-logo.jpg.